Current pain and headache reports
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Curr Pain Headache Rep · Jan 2025
Review Meta AnalysisEfficacy of Transcutaneous Electrical Nerve Stimulation in Management of Cancer Pain: a Meta Analysis.
The present investigation assesses efficacy of transcutaneous electrical nerve stimulation (TENS) on relief of cancer or chemotherapy-related pain. Patients with cancer experience a relatively high prevalence of pain that is reportedly undertreated. Therefore, this analysis is pertinent to determine if TENS is a useful complementary therapy considering its increase in accessibility and minimal side effect profile. ⋯ Related to various limitations of this meta-analysis, no definitive conclusions could be concluded regarding efficacy of TENS in the treatment of cancer or chemotherapy-related pain. Additional randomized primary studies with standardized treatment protocols and pain measurements are needed for future meta-analysis and recommendations for clinical practice.
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Curr Pain Headache Rep · Jan 2025
ReviewEfficacy of Immunotherapy for Complex Regional Pain Syndrome: A Narrative Review.
Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportional pain typically affecting an extremity. Management of CRPS is centered around specific symptomatology, which tends to be a combination of autonomic dysfunction, nociceptive sensitization, chronic inflammation, and/or motor dysfunction. Targeting the autoimmune component of CRPS provides a way to both symptomatically treat as well as minimize progression of CRPS. ⋯ Understanding the physiology of CRPS and strategies for treating and targeting immunophysiology behind CRPS allows examination of the efficacy of such treatments. IL-1 receptor antagonism, glucocorticoid administration, IVIG infusion, and TNFα inhibitors are treatments that target the immune response and decrease inflammation, thereby reducing pain and enhancing function in patients with CRPS. IL-1 receptor antagonism is thought to inhibit the inflammatory effects of IL-1, a key player in the inflammatory process in CRPS. Glucocorticoids have anti-inflammatory properties and can reduce inflammation in affected tissues. IVIG infusion involves administering immunoglobulins, which may modulate the immune response and reduce autoimmunity in CRPS. TNFα inhibitors block the action of TNFα, a pro-inflammatory cytokine associated with CRPS development. These therapies are further discussed at the extent of mechanism of action as well as advantages and limitations of such therapies. The present investigation provides a detailed summary of the mechanism of action, advantages, and limitations of novel immunomodulatory therapies and recent studies and trials that investigated these therapies for CRPS. Future studies are warranted related to the role of immunomodulators in the treatment of CRPS.
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Curr Pain Headache Rep · Jan 2025
ReviewEfficacy, Indications, and Safety of Intrathecal Baclofen Pump: A Narrative Review.
Baclofen, a muscle relaxant that reduces the release of excitatory neurotransmitters in the pre-synaptic neurons stimulating inhibitory neuronal signals in post-synaptic neurons, has been around for over 5 decades. Baclofen is used primarily for spasticity and since 1982, has had a role as an intrathecal agent. In the present investigation, we review research trends and updates on safety and efficacy of intrathecal baclofen (ITB) pumps. ⋯ Evaluation of safety and efficacy of ITB pumps in spasticity and relevant conditions was evaluated in the present investigation. PubMed and ClinicalTrials.gov were used to review appropriate related literature. Commonly reported aspects regarding ITB efficacy include comparison with alternative treatments, maintenance efficacy, and long-term outcomes. Safety considerations and risk factors associated with ITB include postoperative complications, withdrawal symptoms, tolerance issues, long-term management, and contraindications. In summary, the present investigation reveals that ITB is efficacious for muscle spasticity; however, efforts should be made to enhance safety and efficacy by providing improved best practice guidelines on maximum safe dose with the least amount of risk with individualized treatments.
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Curr Pain Headache Rep · Jan 2025
ReviewEfficacy of Transversus Thoracic Plane Block for Pain Management in Cardiac Surgeries.
Effective pain management in cardiac surgery presents as a continuous challenge related to the intensity of postoperative pain and reliance on opioid therapy. The dependance of opioid-based therapies is concerning, as these therapies carry risk future addiction and potential severe side effects. The transversus thoracic plane block (TTPB) has emerged as a promising regional anesthesia technique that blocks the anterior branches of the intercostal nerves in the chest wall, potentially providing improved analgesia for cardiac surgery patients. The present investigation evaluates the efficacy of TTPB in reducing opioid consumption, decreasing postoperative pain scores, and enhancing recovery outcomes in patients undergoing cardiac surgeries. ⋯ Despite these promising results, challenges in technique standardization and limited long-term data are still obstacles that prevent widespread adoption. Achieving consistent TTPB efficacy requires technical precision in ultrasound guidance, and there is little research on its effectiveness across diverse populations, such as pediatric and high-risk cardiac patients. Addressing these gaps through multi-center, long-term studies could help establish TTPB as a prominent pain management strategy in cardiac surgery to minimize opioid dependence and enhance patient comfort and recovery.
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In this article, we explore the current literature on traumatic brain injury (TBI) in survivors of intimate partner violence (IPV) and evaluate the barriers to studying this vulnerable population. ⋯ Research on TBI and IPV is limited by multiple factors including mistrust of the healthcare system by survivors, lack of awareness by community advocates, and insufficient funding by public entities. As such, most investigations are small population, retrospective, and qualitative. Quantitative research addressing the scope of TBI in IPV found reported rates ranging from 19 to 100% of survivors experiencing neurological injury at the hands of a violent partner. The principals of trauma-informed healthcare should guide both neurological care for survivors as well as future studies on TBI and IPV, with an emphasis on community-based participatory research.